Team Training: Unanticipated Difficult Airway

Abstract

Abstract Introduction This is a team-based simulation resource using a SimMan. The resource is designed to expose junior and senior anesthesia residents to a “cannot intubate, cannot ventilate” scenario after a failed spinal anesthetic. Through this experience learners are provided an opportunity to manage a life-threatening airway emergency that plays out in real time, where the correct steps need to be taken in a limited amount of time. Methods This 2-hour session includes a briefing prior to the simulation, the simulation session, and a postsession debriefing. During the session a junior anesthesia resident performs a spinal anesthetic and manages conscious sedation. A senior anesthesia resident manages the situation as an unanticipated difficult airway scenario develops. As this scenario unfolds the team will need to evaluate the preoperative airway. The team will need to recognize the need to call for assistance early in the event, utilize various alternative techniques for airway management, and optimize resource management skills. Results We have used this simulation scenario a total of nine times and a total of 24 residents in two- or three-person groups have participated. The feedback we have received has been very favorable. Discussion This scenario exposes residents to a critical situation which they are likely to encounter during their career as anesthesiologists. This allows them to be able to put theoretical knowledge in practice in a crisis. Errors we observed in the simulator correlated with errors reported to continuous quality improvement. We have found that occasionally residents would fail to follow the American Society of Anesthesiologists guidelines in a crises situation even if they are familiar with these guidelines. The residents tended to “suspend disbelief” and become more involved with the scenario when the simulator responded in a believable way; for instance responding to the oxygen mask being placed over his face.

Keywords

• Anesthesia
• Intubation
• Airway Obstruction
• Pulmonary Ventilation
• Spinal
• Intrathecal